Don’t it always seem to go,
That you don’t know what you’ve got ’til it’s gone.
They paved paradise,
And put up a parking lot.”
-from “Big Yellow Taxi” by Joni Mitchell
An opinion/policy piece appeared two days ago in the New York Times entitled "Why Medical School Should Be Free." Hey, why not? If it’s free it’s for me!
After all, such a system is the rage in many other socialized medical systems.
But rather than focus a critical eye on why medical school has become so exorbitantly expensive, the authors choose to offer a proposal to make it free. By doing so, the authors suggest there is no need for introspection about the antiquated and costly system of medical school education that exists today. There’s no need to reconsider the academic tenure system and it’s burden to state budgets. There’s no need to consider that many university programs are already crumbling under large debt loads and struggling to meet the training and case-load demands of their students, farming them out to private institutions to assure they meet their requisite number of cases.
Heck no. Better to perpetuate the current system and make it free! Students would no longer object to schools that could finally crank their tuition higher! (Trust me, *wink wink,* taxpayers won’t know the difference!)
And don’t worry about the broad-based specialist shortages that exist today. Heck no. It’s all about primary care. Have a hernia and need a surgeon? Or a bypass? Ooops. Not seeing much in this piece to correct our current shortcomings. What’s another $50,000+ per year of education for for those employed specialists-to-be making $37,000 per year as residents?
Mere chump change.
For those military and National Health Service Corps recruiters out there, you’d better start thinking of another incentive program to recruit doctors since offering free medical education in return for a few years of service to your country no longer looks like such a good deal.
Beyond these things, we should also ask: has there been a benefit to patients when medical school’s compete to attract the best and brightest doctors?
Look, it’d be nice if no one had to pay for medical school. (It would be nice if I didn’t have to pay for college education either for that matter.) But let’s not forget the real issue here: doctors are losing all autonomy and ability to advocate for their patients’ needs above those of their employers, be they public or private. Since someone will now be paying a doctor’s tuition, someone else will decide a doctors’ work and level of expertise. Someone else will decide their hours and of course, someone else will decide their pay. As a result, will this new medical school curriculum model shun individual ingenuity in favor of health care budgetary imperatives? When a doctor has little monetary skin in the game, how will such a system assure an adequate work ethic from doctors going forward? I suppose time clocks would work.
Bottom line: there never has been and will never be a free lunch for anyone without some very big strings attached.
Kevin Pho, MD gives his reasoned take on the same New York Times article from the primary care perspective.